Betel Leaves & Areca Nuts and Cancer Risk

Author: OncoLink Team
Last Reviewed: February 28, 2022

The betel plant is a vine that grows in parts of Asia and Africa. Betel quid is made up of slices of areca nuts, wrapped in the leaf of the betel plant. It often includes other ingredients such as slaked lime and spices for flavor. In many countries, tobacco is also added. Betel quid may also be called pan, gutka, ghutka, or gutkha. The use of betel quid is very common throughout the Asia-Pacific region. Use extends to migrant communities in the US, Africa, Europe, and the Middle East.

Preparations of the betel plant, areca nut, and betel quid vary by country and region. A person's risk for developing cancer is increased with betel quid use, although the risk can vary depending on what is in the preparation. Cancer risk is higher when combined with cigarettes or chewing tobacco. Quids are usually held in the mouth for about 20 to 25 minutes. Some users will hold the quid in the space between the teeth and cheek (mandibular groove) for many hours during sleep.

According to the CDC, betel plant, areca nut, and betel quid usage causes an increased risk of developing white or reddened lesions in the mouth that can progress to cancer. Use is also responsible for a condition called oral submucous fibrosis (OSF), in which inflammation and scarring (fibrosis) develop in the lining of the mouth, but can progress to affect the esophagus (swallowing tube). This is a debilitating and irreversible condition that, as it progresses, results in a stiff jaw and an inability to open the mouth. Treatment consists of cutting the fibrous bands in the mouth to allow the jaw to open. Furthermore, the users of betel products and areca nuts are at risk for oral cancers—predominantly those of the lip, mouth, tongue, and pharynx (throat) and cancer of the esophagus.

Learn more about smokeless tobacco and quitting.


International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 100E: Betel Quid and Areca Nut.

Mehrtash, H., Duncan, K., Parascandola, M., David, A., Gritz, E. R., Gupta, P. C., ... & Wen, C. P. (2017). Defining a global research and policy agenda for betel quid and areca nut. The Lancet Oncology, 18(12), e767-e775.

And a summary of this article from the NCI:


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